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Lookup NU author(s): Dr Salman RazviORCiD, Professor Simon PearceORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Background: The optimal duration of antithyroid drug (ATD) therapy in Graves’ disease is uncertain. Although guidelines recommend 12–18 months, shorter courses may be sufficient in selected patients. We evaluated whether ATD duration <12 months is non-inferior to 12–18 months for relapse among patients with Graves’ disease and low thyrotropin receptor antibody (TRAb) levels (>1.8 and <10.0 U/L) at diagnosis.Methods: We analysed real-world data from adults with Graves’ disease and baseline TRAb <10 U/L treated with ATDs at a single centre. The primary endpoint was relapse within 12 months of ATD cessation. A prespecified risk-difference non-inferiority framework was used, with a primary margin of +5% and an exploratory margin of +10%. Treatment effects were estimated using unadjusted analyses, inverse-probability-of-treatment weighting (IPTW; n=369), and 1:1 propensity-score matching (PSM; 104 matched pairs). Secondary outcomes included long-term relapse (median follow-up 58 months), TRAb levels at cessation, and restricted mean survival time (RMST) over 60 months.Findings: At 12 months, relapse occurred in 23/134 (17.2%) patients treated <12 months and 48/235 (20.4%) treated for 12–18 months. The IPTW-adjusted risk difference was –1.5% (95% CI –11.0 to +8.0), meeting the 10% but not the 5% non-inferiority margin. The unadjusted estimate (–3.2%) met both margins, whereas the PSM estimate (+2.9%, 95% CI –7.3 to +13.1) met neither because of reduced precision. Long-term outcomes were similar between groups (IPTW Cox HR 0.90 [95% CI 0.64–1.28]; RMST difference +3.2 months over 60 months [–2.1 to +8.4]). TRAb levels at cessation were comparable.Conclusions: Among patients with Graves’ disease and low TRAb levels, shorter ATD courses (<12 months) produced outcomes broadly comparable to 12–18 months. Although strict non-inferiority was not confirmed at a 5% margin, findings meeting an exploratory 10% threshold support TRAb-guided individualisation of ATD duration and justify prospective randomised evaluation.
Author(s): Razvi S, Holley M, Wheeler H, Vernazza J, Stewart K, Pearce S, Narayanan K, Tsatlidis V
Publication type: Article
Publication status: Published
Journal: Thyroid
Year: 2026
Pages: Epub ahead of print
Online publication date: 21/07/2026
Acceptance date: 01/07/2026
Date deposited: 02/07/2026
ISSN (print): 1050-7256
ISSN (electronic): 1557-9077
Publisher: Mary Ann Liebert Inc.
URL: https://doi.org/10.1177/10507256261470303
DOI: 10.1177/10507256261470303
ePrints DOI: 10.57711/hmd5-0f75
Data Access Statement: De-identified individual participant data that underlie the results reported in this article will be made available to bona fide researchers on reasonable request, subject to institutional approvals, data-sharing agreements, and compliance with relevant data protection and governance requirements. Requests should be directed to the corresponding author. No additional data are available.
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